fecal diversions Flashcards
adynamic bowel obstruction
no structural change, related to an illeus (part of bowel not moving)
ascending colostomy
very rare. stomas will usually be on the right side.
descending colostomy
most common. distal part of colon. usually rectum and sigmoid colon. on the left side. effluent thicker. can regulate poop over time.
ileostomy
in ileum. temporary ones can be reversed.
ostomies - be careful
with skin care. be mindful of fluid intake - monitor for dehydration. even after reversal they usually have b12 deficiencies.
Ileoanal reservoir ex.
J pouch
S pouch
Ileoanal reservoir
reservoir made of bowel. can poop normally or goes into tube.
stoma
proximal brought through the wall of skin
loop stoma
entire loop brought through. they are easily reversed.
stoma bleeding
a little is normal but should be scant
stoma after surgery might be a little
edema. should be back to normal 6-8 weeks after surgery.
if stoma is nectrotic at risk for
peritonitis
mucocutaneous junction
stoma approximated to surrounding skin. sutures should be intact. treated as a wound. shouldn’t have tension and should be attached.
measure height from
mucocutaneous junction
koch pouch (inside kochy)
internal pouch. pt inserts a tube 4-6 times a day
illeoanal reservior (illeana inside)
internal pouch and use rectum to poop.
post op stoma
Assess stoma and peristomal skin
Assess bowel function return (gas or output)
Assess appliance for fit and comfort
Monitor fluid, electrolytes, nutrition
Manage pain
Mobilize
stoma reversal or takedown care
NPO
NGT (sometimes)
Assess for bowel function return
Protect the perineal/anal skin
Start small with liquids and food
Monitor fluids and electrolytes
Assess for complications
Problems with re anastomoses
Post operative ileus
Short gut syndrome
Sluggish bowel
Pain
Infection
nothing spicy
most reversals take how long to normalize?
a year to normalize
goal for pouches
Provide patient with an odor-proof secure pouch
Promote self-care
Cost effective system
sealants
non-alcohol and clear.
powders only used
with sealant to build up skin if a layer is lost.
ostomy care
Gather materials for emptying and changing flange/ pouch
Choose the right time
Change flange/pouch no more than 3 times/week
Size the stomal opening
ostomy - nursing responsibilities
Empty gas in pouch (burping)
Empty pouch when 1/3-1/2 full
Change pouch 1-3 times/week
Assess stoma & lumen
Assess and reassess peristomal skin
Measure stoma with pouch change
Choose correct products to assure fit
Patient teaching
I & O
